West Virginia RN Clinical Denial Coordinator

Job Summary

A company is looking for a Clinical Denial Coordinator - Remote.

Key Responsibilities

• Report, monitor, and analyze clinical denials, coordinating appeals as necessary
• Evaluate patient medical records for discrepancies and negotiate with external auditors on billing issues
• Develop and coordinate training sessions for staff regarding payer denial activity and maintain denial management documentation

Required Qualifications

• Current unencumbered RN license in state of residency or multi-state licensure through the enhanced Nurse Licensure Compact (eNLC)
• Three (3) years of healthcare clinical experience
• Bachelor's Degree in Nursing or Associate of Science in Nursing Degree (ASN) or Diploma; currently enrolled in a BSN program with completion within three (3) years of hire preferred
• Experience in Medical Management for Medicare and/or Medicaid populations is preferred
• Utilization Management experience is preferred